Massive orbital myiasis arising from nasal myiasis in an Indonesian patient with diabetes

PURPOSE: Orbital myiasis is a rare condition. We report a case of massive orbital myiasis (ophthalmomyiasis profunda) arising from nasal myiasis and caused by Chrysomya bezziana in a patient with diabetes. OBSERVATIONS: A 55-year-old woman presented with massive orbital myiasis from larvae invading the entire orbit, with only a small part of sclera and bulbar conjunctiva left of the ocular structures left unaffected. The patient complained of breathing difficulty and drooping of the left eyelid with no other significant complaints. Computed tomography of paranasal sinuses was performed to determine the extent of intraocular invasion of larvae and the surrounding area that might be involved. The larvae filled the nasal and orbital cavity with bony destruction. The patient had a history of diabetes mellitus with uncontrolled blood sugar. CONCLUSIONS AND IMPORTANCE: Orbital myiasis is an infestation of any anatomical structure of the orbit with larvae from the order Diptera. To our knowledge, this is the first reported case of massive orbital myiasis arising from nasal myiasis caused by C. bezziana in a patient with diabetes. Eliminating the causative larvae and topical treatment with antibiotics eye ointment therapy improved the patient's symptoms. Epidemiological data are required to improve documentation of the incidence rate of myiasis.